Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1124583752 |
---|---|
Provider Name | Lei Collette Ong Tan |
First Address | New York, NY 10017-5731 |
Second Address | Brooklyn, NY 11225-3004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2019 |
Last Update Date | 07/02/2019 |